Life-Threatening Coronary Vasospasm Treated by Implantable Cardioverter Defibrillator: The Warning Signs

Abstract

Coronary artery vasospasm is the sudden narrowing of an artery caused by rapid prolonged contraction. It reduces blood supply to the heart and can present with typical cardiac chest pain symptoms. Vasospasm can lead to fatal arrhythmic complications such as ventricular fibrillation. Our case report describes an example of this occurring in a 53-year-old female, and the management plan that ensued. We look at the importance of accurate and prompt diagnosis of vasospasm and how this can have implications for treatment options. One of the available treatments for vasospasm is placement of an implantable cardioverter defibrillator (ICD). This delivers a shock in the event of future life-threatening arrhythmia, with the aim of preventing cardiac arrest. ICD placement, however, is not always a suitable option. This case report discusses the various challenges that arose while making the decision for ICD placement and gives insight into the best available treatment options for coronary artery vasospasm. We also highlight early warning signs that predict life-threatening vasospastic events and how this can be diagnosed and treated appropriately.

Recurrent cardiac arrest and complete atrioventricular block due to idiopathic coronary vasospasm: A case report

“…Temporary pacemaker can be used as a short-term measure for patients who do not respond to drugs or have life-threatening symptoms such as syncope or shock. ICD can prevent death from coronary vasospasm with CAVB, especially when associated with life-threatening arrhythmias [ [9] , [10] , [11] ]. This efficacy has been confirmed by several clinical trials and observational studies.…”

“…In secondary prevention, contemporary guidelines recommend ICD implantation in these patients, if they are already on optimal medical therapy or if medical therapy is not tolerated (Class IIa) [ 12 ]. The indication for ICD should be restricted to life-threatening situations, which are defined by the following criteria: i) ventricular fibrillation or sustained ventricular tachycardia; ii) syncope or cardiac arrest; iii) high-degree atrioventricular block or sinoatrial block; iv) left ventricular ejection fraction less than 35 %; v) familial history of sudden cardiac death or inherited arrhythmia syndrome [ 10 ]. Therefore, we suggest that the risks and benefits of each patient should be carefully assessed, and an individualized decision should be made.…”